Longford County Council
FORM GW80
Complete Appropriate Column
TO BE FILLED BY TRUSTEES OR ORGANISER
(A)
Application No.
as on G.W. 41
(B)
Name of Applicant in
BLOCK LETTERS
(C)
Address of house in BLOCK LETTERS
For office use
only
Domestic Group Water Supply
(D)
Connected to
tap and sink
inside house
(Yes or No)
(E)
Connected to tap
within 10 metres
of house
(Yes or No)
Do not write in
this column
(A)
Application
No. as on
G.W. 41
(B)
(C)
Name of Applicant in Address of house in BLOCK LETTERS
BLOCK LETTERS
(D)
Connected to
tap and sink
inside house
(Yes or No)
(E)
Connected to tap
within 10 metres
of house
(Yes or No)
Do not write in
this column
(A)
Application
No. as on
G.W. 41
(B)
(C)
Name of Applicant in Address of house in BLOCK LETTERS
BLOCK LETTERS
(D)
Connected to
tap and sink
inside house
(Yes or No)
(E)
Connected to tap
within 10 metres
of house
(Yes or No)
Do not write in
this column
(A)
Application
No. as on
G.W. 41
(B)
(C)
(D)
Name of Applicant in Address of house in BLOCK LETTERS
BLOCK LETTERS
Connected to
tap and sink
inside house
(Yes or No)
(E)
Connected to tap
within 10 metres
of house
(Yes or No)
Do not write in
this column
Certificate of Completion of Scheme and Provision of Domestic Group Water Supplies.
We, the Trustees of the ____________________________ Group Water Scheme, County Longford,
hereby certify that the scheme has been completed satisfactorily and that the domestic group water supplies have been
provided to grant applicants listed above, and we request payment of any grants outstanding to the group.
Signature of Trustees:
_________________________________________
_______________________________________
_________________________________________
_______________________________________
Date:____________________
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Rural Water Liaison Officer, Longford County Council, Great Water Street, Longford